ISSN: 2322 - 0902 (P)

ISSN: 2322 - 0910 (O)

International Journal of Ayurveda
and Pharma Research

Case Study

AYURVEDIC MANAGEMENT OF HANUSTAMBHA: A CASE STUDY

Malini Moger1*, S.N.Belavadi2
*1P.G.Scholar, 2Professor & H.O.D, Department of P.G. Studies in Kayachikitsa, D.G.M.Ayurvedic Medical College,
Gadag, Karnataka, India.
ABSTRACT
Life without movement is impossible to think of in a healthy person’s normal life. Hanugraha or
Hanustambha is one of the commonest problem affects irrespective of sex, age and socioeconomic
status etc. The disease has the symptoms like stiffness of jaw with or absence of pain. The
symptoms are seen suddenly with chronic Nidana Sevana. Jaw dislocation occurs when the lower
part of the jaw moves out of its normal position. Temporomandibular joint disorder can cause
pain, abnormal joint movements and joint noises. The life time incidence of Temporomandibular
joint disorder is more than 10 million cases per year in India. In Hanugraha, Vata is predominantly
involved. Here an attempt is made on Hanustambha with Ayurvedic management.
KEYWORDS: Hanustambha, Lock Jaw, Ksheerabala Taila, Mahayogaraja Guggulu, Dashamoolarista.
INTRODUCTION
Ayurveda is a science which has the capability  Hanustambha– Lock jaw, the patient is unable to
to revert the condition to maintain homeostasis open or close the jaw
without causing any harm on the body. Acharya  Hanumulabandhana – Binding elements at the root
Charaka quoted Hanustambha in Vataja Nanatmaja of jaw
Vyadhi.[1] Lock jaw refers to the condition of having
 Hanvauscaprasiddhi- Stiffness of jaws
difficulty in opening the mouth due to spasms in the
muscles which helps for mastication. Lock jaw is also As mentioned Hanustambha under Vata
seen as one of the symptoms in Tetanus which is vyadhis, the affected Dosha is Vata in this disease.
called Trismus. The symptoms includes xerostomia Nidana : Due to Nidhanas like Jihwa Nirlekhana,
[7]

(dry mouth), Mucosities, Headache, Jaw pain,
Earache, speech difficulties etc. This disease is very
rare in children but most commonly seen in
teenagers, young adults and old age.
The medicines used here are Ksheerabala
Taila[2] for Abhyanga to the Hanupradesha and at
Karnamoola Pradesha. Here as Bahya chikitsa,
Abhyanga and Nadi Swedana is done to loosen the
joint stiffness and to relieve the aggravated
Vatadosha. And internally Dashamoolarista[3] which is
having Vata Kaphara property and Mahayogaraja
guggulu[4] which is told as best in Vatavyadhi in
which Vata Pradhana is seen.
Hanustambha
Definition
‘Hanugraha sa tena syat kruchra charvana
bhashanam’ [5]
That which makes difficulty in chewing and difficulty
in speaking is termed as Hanugraha or Hanustambha.
Paryayas[6]
 Hanugraha– Stiffness of jaw- bones or lock jaw
Shushka Charvana, Abhighata, Vata increases which
is located near Hanumoola and loosens the joint of
lower jaw, making the mouth either open or close the
mouth causing difficulty in Charvana and Bhashana.
Acharya Bhavamishra gives meaning to each
Nidanas like Nirlekhana= Karshana, Shushkam=
Chanakadi, Vivrutasyatvam=Vyattamukhatvam and
Samrutasyatam= Dantalagnataam[8]
Samprapti
Due to intake of Shushka, Katina Padartha Sevana-
Vitiates Vayu- Lodges in Hanusandi- Leads to
difficulty to open or close the mouth- this disease is
named as- Hanugraha.
‘Hanugraham Cha Samstabhya Hanum Stabdham
Avedanam’[9]
Acharya Charaka explains as when Vayu
located at the root of the jaw, it causes jaw to slip
down from its joints and consequent opening of
mouth or by stiffening the jaws it causes closing of
mouth, which is characterized by stiffness and
absence of pain.[10]

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 Int. J. Ayur. Pharma Research, 2019;7(6):27-31
Lakshanas  Dental treatment- in acute phases like heat
Hanustabdha- Stiffness of Hanusandhi therapy, analgesics, a soft diet, muscle relaxants,
Avedanam- With or without pain initiating physiotherapy for opening and closing
mouth when the acute phase is over.
Vyapathu- Shivering
 Drug therapy- NSAIDs like ibuprofen or naproxen
‘Vivrtam Samvrtam Va Aasyam Yaha Kuryat Sa
can relieve muscle pain and swelling.
Hanugraha’.
 Wearing a splint, manual therapy, and temporo-
It is of two types as difficulty in opening and closing
mandibular joint exercises.
the mouth i.e.,
Treatment in Ayurveda
i. Open lock jaw
Nidana Parivarjana is the first line of
ii. Closed lock jaw.[11]
treatment which should be followed as it is told
Acharya Yogaratnakara adds Vyapathu along with the ‘Prevention is better than Cure’. Hanugraha
above said symptoms.[12] presenting with mouth still open, should be managed
Sadhyasadyata: If the disease is located in Asthi and priory by Snehana and Swedana. The jaw should be
Majja are said to be Yapya or Asadhya due to pressed with thumbs and raised with index finger.
deepness of their location. The disease is curable if Then the chin should be lifted up to set in position.
they are new, free from Upadravas and in Balavan The displaced jaw should be brought to its normal
patients.[13] position. If the jaws are too rigid, then it should be
 Lock jaw, also called Trismus is a medical subjected to Snigdha swedana.[14]
condition causes swelling, pain and dysfunction in Acharya Vangasena adds as in Samvrita
the Temporomandibular joint. Jaw feels locked Avasta, Chikitsa should be done as Snehana and
due to muscle spasms and inflammation, making Swedana and then the lower jaw is pulled backwards,
the person unable to shut or open normally. downwards and forwards and in this way the mouth
 Lock jaw typically affects only one side of the jaw is made open. This action loosens the muscular
which is harmless and treatable. tissues which have become rigid due to location of
 Causes are divided into intra- articular (factors joint. And same procedure is done in opened
within the temporomandibular joint) and extra- mouth.[15]
articular (factors outside the joint). Acharya Vangasena adds as for setting the
 Intra- articular causes includes joint or for keeping the mouth in place, Guda and
 Internal derangement of TMJ/ meniscus Pakva Bimbi Phala should be used as pad to be kept
displacement near the joint between the teeth.[16]
 Fractured mandibular condyle Acharya Bhavamishra tells some of the combinations
of Dravyas[17] like
 TMJ dislocation
 Osteoarthritis • Pippali + Ardraka- ask the person to chew
frequently and wash the mouth with warm water.
 Ankylosis
• Lashuna is made into small pieces and asked the
 Bruxism (teeth grinding) person to eat with Saindava Lavana and Tila Taila.
 misaligned teeth • Abhyanga with Pakwa Taila followed by Manda
 stress Swedana and later Tailapoorna Basti Dharana.
 too much chewing • Rasonagutika + Masha- with Saindava Lavana +
 opening the jaw too wide Ardraka + Hingu + Tila Taila – given based on Agni.
 infection (Tetanus) Some of the Yogas explained for the disease
 Some oral diseases, etc. Hanustamba are
 Extra-articular causes  Trayodashanga guggulu- 3 grams, Anupana with
 Tetanus Triphala Kwatha, Gritha, Madhu, Lashuna
 Meningitis Swarasa, Yusha and Mandoshnajala.
 Parotid abscess  Vidangasava- 12-24ml, Anupana with Jala.
 Brain abscess  Mahanarayana Taila- 6 grams, used externally for
Nasya, Abhyanga and also, Anupana with Ksheera
 Treatment and Ushnajala.
Elimination of etiologic agent along with antibiotic  Mahamasha Taila - 6grams, used externally for
coverage. Basti, Abhyanga and Nasya, Anupana with
Primary immunization (DPT) Ksheera and Ushnajala.
Available online at: http://ijapr.in 28
 Malini. Moger, S.N.Belavadi. Ayurvedic Management of Hanustambha
 Yogaraja Guggulu– 3grams, Anupana with
Rasnasaptaka Kwatha, Lashuna Swarasa and
Madhu.
 Snehana with Prasarini Taila or Baladi Taila for organomegaly.
Abhyana.
 Pippali Churna with Dashamoola Kwatha taken
internally.
 Maharasnadi Kwatha- 48ml, Anupana with Jala.
 Dwatrimshaka Guggulu– 1 kola (gms) with Ghrita
and Madhu after food.
 Narayana Taila - 6 grams, used externally for
Nasya, Abhyanga and Anuvasana, Anupana with
Ksheera and Ushnajala.
 Prasarini Taila- used externally for Abhyanga
Brief History about patient
Male Patient by name ABC of 17 years old doing work
as a shepherd.
Chief complaint was unable to open his mouth and
difficulty to speak since - 4 days.
Associated with pain over temporomandibular joint
History of present illness: Patient was apparently
normal 4 days back one day suddenly noticed unable
to open the mouth and difficulty to speak. Patient
also complains of pain in temporomandibular joint.
The pain is severe in nature so disturbed in his
routine work.
Patient also noticed disturbed sleep due to pain and Mukhaabhyanga followed by Nadisweda - 7days
difficulty in taking and chewing the food.
For this problem the patient has taken treatment
from the local doctor but not found relief.
No History of fall/ trauma or any eternal cause.
Images showing performing treatment, before treatment, after treatment and after follow up
CVS- S1 S2 heard
R.S- Normal vesicular breath sounds heard
Per abdomen- Soft, No tenderness and No
Rest other systems are found to be normal
Examination findings:
X-ray of temporal mandibular joint
• In this patient closed type- only because of tissue
injury no abnormality found in X –ray
• Subluxation of temporomandibular joint
Other investigations
 Magnetic Resonance Imaging – shows if the TMJ
disc is in the proper position as the jaw moves.
 Computed tomography- shows the bony detail
of the joint
Materials and methods
Treatment schedule
• Ksheerabalataila Mukhaabhyanga followed by
Nadisweda for 7days.
• Mahayogarajaguggulu 1 (500mg) tid for 15 days
• Dashamularishta 4tsp tid with equal water after
food for 15days.
• Cap- Flexy –MR 1bd with water after food for
15days.
Duration
Shamanoushadhas- 15days
Follow up- 8 days
Total study duration- 30days

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 Int. J. Ayur. Pharma Research, 2019;7(6):27-31

Image 1 and 2 Showing Mukha Abhyanga with Image 6 Showing after follow up of 15 days patient
Ksheerabalataila. opened mouth and shown tongue up to 75%.
Image 3 Showing Dashamula Siddha Kwatha Image 7 Showing before treatment patient difficult
nadisweda. to move mandibular Joint.
Image 4 Showing before treatment patient difficult Image 8 Showing after treatment slight movement of
to open mouth. mandibular joint and along with mouth opening.
Image 5 Showing after treatment patient opened Image 9 Showing after follow up of 15 days patient
mouth and shown tongue protrusion up to 50%. opened mouth and shown tongue protrusion
completely.
RESULTS
Lakshanas Before treatment After treatment
Hanustabdha Present Absent
Difficulty in opening mouth Unable to open Easily can open
Showing tongue Unable to do Can do easily
Difficulty to speak Unable to speak Can speak properly
Pain at temporomandibular joint Present Absent
The Pathyas and Apathyas are same for all  Here, in this patient, along with Bahya Chikitsa,
types of Vatavyadhis. The food which comprise of Shamanaushadhis are also given to relieve the
Madhura-Amla and Lavana Rasa, Snigdha, symptoms. Externally, Mukha Abhyanga with
Santarpaka, Pachaka and Anulomaka are said to be Ksheerabalataila followed by Dashamoola
wholesome. Nadisweda done for 7 days continuously.
Pathya  Ksheerabalataila is having the ingredients like
Pathyas are Raktashali, Yava, Goduma, Bala, Tila Taila and Ksheera which are having
Kulattha, Masha, Tila, Chatursnehas, Draksha, Karjura, Vatahara property and has Rasayana effect. For
Lashuna, Jeeraka, Gramya and Anupa Mamsa and Nadi Sweda, Dashamoola Kwatha is used in which
Ajamamsa etc. the drugs are having best Vata Kapha Shamaka
Apathya property in which the symptoms like stiffness and
pain is relieved.
Apathyas are Chanaka, Kshara, Sheetalajala,
Viruddha Bhojana, Katu, Tikta, Kashaya Rasa  Internally, Mahayogaraja Guggulu 500mg tablet
Pradhana Dravyas, Madhu, Atimaithuna, twice a day with lukewarm water after food,
Raatrijagarana, Chinta, Shrama, Vegadharana, Dashamoolarista 4tsp thrice a day with water after
Vamana, Langhana and Saahasa etc. food and Cap. Flexy- MR 1 tablet bd after food with
water, all for 15 days are given.
DISCUSSION
 Mahayogaraja Guggulu consists of ingredients like
 Hanugraha or Hanustambha is a type of
Triphala, Panchakola, Jeeraka Dvaya, Hingu,
Vatavyadhi in which the symptoms like Stabdata,
Ajamoda, Pata, Vidanga, Gajapippali, Renuka,
Aruja and Vepatu of the Hanusandhi is seen.
Kutaja, Ativisha, Bharangi, Vacha, Murva, Guggulu
 Due to Vatavruddhikara ahara and Vihara, Vata and Rasaushadhis like Bhasmas of Naga, Vanga,
dosha aggravates and cause the disease Rajata, Loha, Abhraka, Mandura and Rasa Sindhura
Hanustambha. which are having Vatahara properties and
 In Ayurveda different treatment modalities have Dashamoolarista is having 72 ingredients which
been explained both Bahya and Abhyantara. mainly acts on Vata and Kaphadosha. Thus by the
Available online at: http://ijapr.in 30
 Malini. Moger, S.N.Belavadi. Ayurvedic Management of Hanustambha
treatment given to the patient, found complete 8. Pandit Sri Brahma Sankara Mishra,
relief like opening and closing of mouth after 30 Bhavaprakasha, Chaukamba Sanskrit Bhawan,
days of treatment. Varanasi, Volume 2, Eleventh Edition 2010, 24th
CONCLUSION Chapter, Shloka no. 24-25, Page No. 226.
 Hanustambha is a disease of Vatavyadhi. 9. Nirmala Saxena, Vangasena Samhita, Chaukamba
 This clinical study proves that most of the Sanskrit Series Office, Varanasi, Volume 1, First
Ayurvedic drugs used possess Vata and Edition 2004, Shloka no.98-99, Page No. 401-402.
Kaphahara property. 10. Prof.Priyavrit Sharma, Charaka Samhita,
Chaukamba orientalia, Varanasi, first edition
 The drugs which are present in the Yogas used in
1983, Volume 2, Chikitsasthana 28th chapter,
this study are effective in Hanustamba.
Shloka no. 49, Page No. 465-466.
 Research scholars can also opt Kukkutanda Pinda
11. Dr.Madham Shetty Suresh Babu, Yoga Ratnakara,
Sweda in Hanustamba for clinical study in large
Chaukamba Sanskrit Series Office, Varanasi,
sample size.
Second Edition 2011, Hanustamba chapter, Page
REFERENCES No.610.
1. Prof.Priyavrit Sharma, Charaka Samhita, 12. Dr.Madham Shetty Suresh Babu, Yoga Ratnakara,
Chaukamba orientalia, Varanasi, first edition Chaukamba Sanskrit Series Office, Varanasi,
1983, Volume 2, Suthrasthana, 20th chapter, Second Edition 2011, Hanustamba chapter, Page
Shloka no. 49, Page No. 465-466. No.610.
2. The Ayurvedic Formulary of India, Part -1, 13. Prof.Priyavrit Sharma, Charaka Samhita,
Second Edition, the Controller of Publications Chaukamba orientalia Varanasi, first edition
Civil Lines, Delhi, Page No. 132. 1983, Volume 2, Chikitsasthana 28th chapter,
3. The Ayurvedic Formulary of India, Part -1, Shloka no.72-74, Page No. 468.
Second Edition, the Controller of Publications 14. Prof.Priyavrit Sharma, Charaka Samhita,
Civil Lines, Delhi, Page No. 13. Chaukamba orientalia Varanasi, first edition
4. The Ayurvedic Formulary of India, Part -1, 1983, Volume 2, Chikitsasthana 28th chapter,
Second Edition, the Controller of Publications Shloka no.102-103, Page No. 471.
Civil Lines, Delhi, Page No. 68. 15. Nirmala Saxena, Vangasena Samhita, Chaukamba
5. Sri Taranatha Tarkavachaspati, Vachaspatyam, Sanskrit Series Office, Varanasi, Volume 1, First
Chaukamba Sanskrit Series office, Varanasi, Edition 2004, Shloka no. 100, Page No. 402.
Volume – 4, Page No. 5416. 16. Nirmala Saxena, Vangasena Samhita, Chaukamba
6. Dr.Kanjiv Lochan & Dr. P.S.Byadgi, Encyclopedic Sanskrit Series Office, Varanasi, Volume 1, First
Dictionary of Ayurveda, Chaukamba Publications, Edition 2004, Shloka no. 101, Page No. 402.
New Delhi, First Edition 2011, Page No. 298. 17. Pandit Sri Brahma Sankara Mishra,
7. Prof.Priyavrit Sharma, Charaka Samhita, Bhavaprakasha, Chaukamba Sanskrit Bhawan,
Chaukamba orientalia Varanasi, first edition Varanasi, Volume 2, Eleventh Edition 2010, 24th
1983, Volume 2, Suthrasthana, 28th chapter, Chapter, Shloka no. 24-25, Page No. 226.
Shloka no. 49, Page No. 465-466.
*Address for correspondence
Cite this article as: Dr. Malini. Moger
Malini. Moger, S.N.Belavadi Ayurvedic Management of Hanustambha- A 2nd year P.G.Scholar,
Case Study. International Journal of Ayurveda and Pharma Research. Department of P.G. Studies in
2019;7(6):27-31.
Kayachikitsa, D.G.M.Ayurvedic Medical
Source of support: Nil, Conflict of interest: None Declared
College, Gadag, Karnataka.
Mobile: 8310961804
Email: malinimgr12345@gmail.com

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